Table 2.

Participant Recommendations for SMARTtest App Components

A. User Mode

• There should be an option if you’re testing yourself or someone else, and then once someone else is -- once the whole test is complete, I won’t see the results on my phone. It’ll be automatically texted or e-mailed to them and then once I’m done all their info should be wiped away. (PTID149)

• Definitely seems like there should be some kind of guest mode so that it’s clear this is not data for the primary user. And once that data gets sent along to the secondary user, that it is gone from your own phone so that you aren’t carrying someone else’s data around.(PTID115)

• If you want your result, then you need to download the app and buy the device. I can test you and we can see, but I can’t save it. (PTID126)

B. Instructions

• I thought it was fantastic. They were very simple. I like the video. I thought after the video you were just -- like that was it and you’re going to leave me in the forest and I was like, whoa, this is a lot for the first time. But the app instructions were great, because each step, you do the step and then you go on to the next one and it’s very straightforward. The images are clear. It’s easy. (PTID185)

• I got nervous during the test because I kept on bleeding, but I didn’t know if I could pause to put a gauze on my -- I got nervous that, oh my gosh, if I don’t put this in soon, I’m going to invalidate the result. So it might be nice if there were some instructions: OK, if you want to pause here and, you know, wipe your blood, or -- because I was, like, dripping and I was like, oh my God! (PTID109)

C. Results Display

• Maybe a little bit of a warning -- your results will be displayed in just a few moments. I guess, like, take a deep breath, or in the event that it’s positive, an 800-number will be displayed afterwards. Or -- (pause) yeah. I guess, maybe a recommendation. You know, like,“If this should come back positive, and this is your first time, it’s recommended to do the following: get a follow-up exam, contact your primary physician,” something to that effect. (PTID159)

• Well, when you say is there anything more, if it -- if the page comes up positive, I would always have right there, there is help. That you can get help. Because sometimes just leaving, and just looking at that and it’s just saying positive and just nothing else -- nothing to reinforce the fact that it's not a death sentence. (PTID150)

D. Results Management

D1. Saving Test Results

• I’ve been asked, ‘When’s the last date you’ve been tested?’ and sometimes I’m like, ‘You know, I know I got tested in December, I think it was around—’ and so to be able to pull up an app and go, ‘Yeah, I got tested December 4th, and that was the result.’ (PTID126)

• I think that would be great just to be like,“Look, here is the history of every month I’ve tested myself. Here’s the whole history of—they’re all negative, right?”… It’s keeping data. It’s like, I keep track of how many steps I take every day. (PTID115)

•The results should be sent straight to e—mail or text. We don’t see it…I should just know that the test is complete. All the info should be wiped out of my history, and then keep it moving.(PTID149)

• You don’t want to take a chance on letting anybody see what you don’t want them to see. So, that [delete] should definitely be an option, whether it’s used or not. (PTID124)

• Disadvantages of saving it is that, once it’s on your phone, anyone can break into your phone. Like, these phones are easily hacked, so you just don’t know who’s going to hack into your phone, or who’s going to see those results, or who can be nosy, and you leave your phone on the bed, and you’re with a partner, or you’re going to be sexual with this person, and this person decides to go through your phone. (PTID192)

D2. Sharing Results with Sexual Partners

• It’s almost like an ID card. You need to know my status? Here’s proof, this is my status. (PTID153)

• Some gay men are like“I need lab results from you before we even go on a date because I’m not going to be with somebody who’s HIV-positive, so I need to know that you’re completely STD-free”. So being able to take the test at home and being able to then send them to people through some kind of authenticated system, that would be advantageous. (PTID109)

• You can throw it in the cloud someplace and be able to grab it afterwards. … Just so no one can get into it. Just so I’d be the only one. It’d have to be some type of passcode or something like that, that I can go in and retrieve it afterwards… no name, just have a number on it (#174)

• I love that notion of putting it on the [hookup] apps because they’re already advancing with like, statuses and what do those statuses mean.” (PTID141)

• If it could link to hook-up apps, like directly, like get your status out there and maybe—instead of a person’s claimed status, it could be like a verified status. (PTID123)

• So kind of like on social media where you have a share button and often with different options of what to share through, same thing. Something that will just get a nice little picture of me, my ID, my status, so that I can use as proof that say I’m negative and be able to text it, email it, WhatsApp it, Facebook, Messenger it, whatever. (PTID132)

• You should never have the results on a dating app. I mean, there’s already dating apps for HIV-positive men. Like, that’s some really personal stuff, not just personal, but, like, I don’t know that it should be as simplified or as conversational as that. (PTID204)

• Now I have his negative result on my phone, and I take that to the next person.“Hey, I’m negative.” You know, there’s no way … that doesn’t mean shit. That could be anybody’s. It could be your friend sent it to you, so I think there should be some sort of identifying. (PTID122)

• How do I know those are your results? How do I know? But you’ll never know unless you’re actually standing there with someone when they take the test. … So there’s no way for you to know. So I don’t think that’s an issue that we could do anything about. (PTID126)

• That seems very fundamental. Like I said, I should be able to send a text message to someone that was like,“Hey, yo! You should go get tested!” Right? (PTID115)

D3. Sharing results with physicians

• Well, if it tested positive, I would definitely send it to my doctor. And then I’ll delete them from my phone. (PTID185)

• If it’s all negative, then you would have a share button,“share on Grindr or GROWlr,” or, if it’s positive,“share with your physician,” doctor, or whoever. While setting up the app with your username, your email, everything, maybe there's a suggestion that you connect your physician to the app, or a hospital or whatever. (PTID122)

• I actually suggested incorporating it with apps like MyChart or Helo. They’re communication apps that you can use for your test results and to communicate with a doctor in a secure environment and check your appointments and lab results and stuff like that. So you could use that to transmit it to the doctor directly. (PTID151)

• I think it depends on the results. I think if they’re negative, then it’s kind of nice to have to share with people (partners, doctor), just like a confirmation. If they’re positive, then that’s a little harder to swallow, but probably want to share it with a medical provider, your doctor. (PTID165)

E. Information

E1. About the test

• I would want to know what the window is between HIV infection and when it can be detected on the blood test… if there’s a guy who is more sexually active, and he’s had a lot of unprotected sex in the past 90 days, it might make me feel a little bit more reluctant because maybe he’s picked up something that the test can’t pick up on yet. (PTID109)

• What the window period actually is and means. Because if you test this date, it really should say well this only covers up until three months ago. (PTID124)

E2. About HIV and syphilis

• What to look for: Signs, symptoms, and how to protect oneself as far as risky behavior. The things that you don’t want to do, unknowingly. Same thing with HIV. Just basic stuff. Nothing too -- you know, pre- and post-prophylactic stuff like that. Seroconversion, just basic stuff. (PTID125)

• On the app I think there should be links. You don’t want to put too much stuff on apps because then people are like“Yeah, yeah, yeah. Too much.” But you want to put links to the CDC site. This is HIV and this is what the test means. To the New York City Department of Health site about syphilis because they would probably say, you can go to these clinics. (PTID126)

• I would keep it to basic facts about HIV and syphilis, but focus on referrals and next steps rather than trying to be a major resource within the app. I wouldn’t want someone to think that the app had all the answers, so the fewer answers it has the less risk there is of that and the more likely for someone to go and speak with a medical professional if they get a positive result. (PTID137)

• Just the information on syphilis itself and how you get it, how long it stays in your system, stuff like that. I think most people is more in tune with HIV and how you get it and how it lays there, so definitely the information about syphilis is important. (PTID174)

E.3 Linkage to Care

• Probably a link, or like a numbers to call. I guess just to give people a safe place to go and speak to the doctor. Probably places that -- with low cost or no cost at all. Probably a page there for people whose -- in the LGBT community, because I know this is not only for just people who are gay, but straight people as well can use this, and I guess like -- because sometimes, some people don’t like going to regular clinics. (PTID103)

• I would say mainly department of health they are the ones that do the free services. So knowing any free clinics and/or CBOs that provide STI screenings and/or treatment. (PTID135)

• Since it’s smart phone-enabled it’s definitely going to have GPS, so it can recognize the clinics that are sort of near you. Then it can show you the clinics that are nearby, the hours of operation” and it can probably be linking all the websites of each clinic. (PTID160)

• Besides nearest doctors and testing locations, being basic bare bones would be much better. Resources are always good, but sometimes, people have their own resources. (PTID165)

• I’m a gay man living in Chelsea, New York. I have a gay doctor. My friends are all gay. Many of my gay friends are doctors. I have no trouble seeking good medical care. (PTID147)

• I would say, primary doctors, because a clinic is a clinic. So, you can just go by the clinic. But maybe a list of resources with doctors who specifically have knowledge of how to deal with someone who’s HIV positive. I will go to a doctor that only knows about hormones, you know? I’m not going to go to a doctor that doesn’t know nothing about hormones. So, a doctor like that, like, ah, OK, these are doctors that are special -- a specialist in HIV care. (PTID192)